Development and Validation of a Prognostic Model for One-year Survival of Cirrhosis Patients with First-ever Spontaneous Bacterial Peritonitis.

ABSTRACT

BACKGROUND AND AIMS: Spontaneous bacterial peritonitis (SBP) is one of the leading causes of death in patients with liver cirrhosis. We aimed to establish a prognostic model to evaluate the 1-year survival of cirrhosis patients after the first episode of SBP. METHODS: A prognostic model was developed based on a retrospective derivation cohort of 309 cirrhosis patients with first-ever SBP and was validated in a separate validation cohort of 141 patients. We used Uno's concordance, calibration curve, and decision curve (DCA) analysis to evaluate the discrimination, calibration, and clinical net benefit of the model. RESULTS: A total of 59 (19.1%) patients in the derivation cohort and 42 (29.8%) patients in the validation cohort died over the course of 1 year. A prognostic model in nomogram form was developed with predictors including age [hazard ratio (HR) 1.25; 95% confidence interval (CI) 0.92-1.71], total serum bilirubin (HR 1.66; 95% CI 1.28-2.14), serum sodium (HR 0.94; 95% CI 0.90-0.98), history of hypertension (HR 2.52; 95% CI 1.44-4.41) and hepatic encephalopathy (HR 2.06; 95% CI 1.13-3.73). The nomogram had a higher concordance (0.79) compared with the model end-stage liver disease (0.67) or Child-Turcotte-Pugh (0.71) score. The nomogram also showed acceptable calibration (calibration slope, 1.12; Bier score, 0.15±0.21) and optimal clinical net benefit in the validation cohort. CONCLUSIONS: This prediction model developed based on characteristics of first-ever SBP patients may benefit the prediction of patients' 1-year survival.